I was recently diagnosed ADHD in my 50s but in my case it is the impulsivity is the main symptom, that results in anger, stress and anxiety, which appears to be caused by RSD. My doctor prescribed Adderall which has helped with focus issues but done almost nothing for the RSD related stuff. I’m going to try to find a psychiatrist and inquire about guanfacine, as I suspect much of the classic attention / focus issues are due to RSD .

I think it is irresponsible to say that psychotherapy doesn’t help patients with RSD. You are underselling the value of therapy in helping people to identify and understand their internal processes and develop coping skills for RSD reactions. The article reads like a love letter to psychiatry from that point. You have lost a regular reader and advocate for your website.

Can’t wait until people start recognizing ADHD as being linked to dissociation spectrum disorders.
These are not novel symptoms. This is not unexpected. This is exactly what you’d expect to see from someone benefitting from/struggling with dissociation. ADHD is highly correlated with trauma in a lot of ways, it really needs to stop being its own subclinical diagnosis.

This is the reason that a purely categorical system is so dangerous for the mental health narrative in the US & etc. Van der Kolk and co have worked a ton at bringing complex trauma into the narrative, but the politics of the scene really don’t allow for that as much, at least at the broader levels that I can see.

What you get with a purely categorical system is reinventing the wheel many times over without being able to connect seemly disparate concepts, a common problem with attempting to model a higher dimensional problem with a lower dimensional projection. You lose your locality constraints because things can’t reasonably live “next to” each other, and so you get branching tree structures that are clones or near-clones of each other.

Someday we’ll move past this. RSD is just another name for a protector response, which is generally mediated by the lack of the prefrontal cortex operating as much as it does normally paired with the fight-or-flight (+ the other fs) resulting from an engrained trauma response. You also get shutdowns, etc that aren’t accurately described by RSD, because it fails to capture the breadth of what’s actually going on behind the scenes there.

Unfortunately the state of mental health in America is rather barbaric at the moment, it’ll in all likeliness be the thing we look back on in 50 years like we do at smoking. However, it’s a good reminder that even though we’re at the latest year we’ve ever been to as a world, we’re not “all the way there” on things, and never quite/exactly will be.

It is as if we are casting aside a compliment from someone because that they are trying to connect without having been vetted first. And that vetting is simply “Are you judgmental?”

In order to have the sense of controlling judgement, I will throw out a wildly disturbing joke know that there will be people who say “You are terrible” to people who try not to laugh but lose total control.

When I met my wife for dinner she texted me that there was a 30 minute waiting period. My wife gives amazing hugs, so when I found her she gave a full melt hug and said “I am comfortably numb. You’re like Cosby but without the quaaludes ” and someone behind me told me how awful I was and I just smirked, because I knew there would someone I would offend. I was ok because I felt in control of their judgement.

I you are coaching a kid with RSD and you establish that when you deliver consequence it will be without the tone of judgement, it is so easy to get them to pivot. Works every time.

1. What is described as RSD is claimed to be exclusive to ADHD, but similar experiences have been described in conditions such as borderline personality disorder; also, what is described as RSD can describe symptoms of early childhood trauma. The material I have seen thus far online, including this article, do not sufficiently address this or account for the possibility that RSD is actually a manifestation of trauma.

2. Dr. Dodson does not differentiate between RSD directly caused by ADHD versus RSD that may actually be caused by children with ADHD having an increased exposure to trauma, and/or kids with ADHD possibly being more sensitive to their environments. In terms of trauma, we know that kids with ADHD are more likely to experience mistreatment. One may argue that RSD is the result of ADHD mediated through trauma, but this would be problematic because ADHD does not cause child maltreatment (people who maltreat are responsible). It is quite likely that kids with ADHD are more sensitive to their environments, but this paints a more complicated picture of ‘nature’ and ‘nurture’ interacting than the implication that RSD is ‘nature.’

3. Dr. Dodson does not present research supporting his claims on RSD. This article, and other material I have seen on RSD thus far, does not point to scientific literature. While an article written for a public audience will not go into detail, it is common for educational material written for a public audience to reference peer reviewed studies on a topic when they exist. I searched for peer-reviewed articles from Dr. Dodson on this topic and came up empty-handed. I have not seen other researchers examine Dr. Dodson’s claims either. Granted, I did do a minimal search in only one database, but that search pulled up irrelevant articles, which I have found is a pretty good indication that literature on a topic is lacking.

Presumably Dr. Dodson’s work on RSD is informed by his clinical interactions with patients. Not all clinicians have training or inclination to do research, but one would hope that there would at least be some case studies in the literature. Case studies are a low bar as far as scientific evidence is concerned (they are generally good for identifying topics for more research and cannot get at the issue of confounding, which is the issue I have raised regarding RSD possibly being caused by trauma) but case studies would at least provide a foundation for research with better methods.

Some clarifications:

A. I am not saying that RSD is not distinct to ADHD, and I am not saying that RSD is caused by trauma. I am saying that: 1) the material I have seen on RSD thus far does not sufficiently distinguish RSD from similar experiences that have been described outside of people with ADHD; and 2) the material I have seen on RSD thus far does not sufficiently address the possibility that RSD may be caused by ‘nurture’ rather than ‘nature.’

B. I am not disputing the experiences of those who report RSD. I am just saying that we do not know if those experiences are best described as an inevitable or fundamental part of ADHD. (Re-read point A above.)

I also actually *did* find keeping in mind what I’d learned in CBT helped, though the text of the article makes it sound like my results in that regard are less common… I’ve been at my current job for a little over half a year and there’s been several situations where I would’ve melted down in the past, (or booked it to a stall in the women’s room to meltdown ASAP afterwards,) where I didn’t, and I honestly think it’s a mix of Adderall (I find the side-effects less troublesome than Ritalin’s, but that’s just my body,) and CBT.

I remember that, around 4th grade or so, my parents tried Chlonodine (with Ritalin,) possibly for this very condition, (the documentation is long since gone and my parents can’t remember that sort of detail at their ages,) but it didn’t help with spit and I came close to passing out so often that they stopped. (Granted, this was right around the time that Asperger’s was entering the DSMIV-TR, so there was this whole other factor that was never being addressed. Add on that autistic brains don’t always handle Brain Medicine like non-autistic brains with the same condition do… I don’t begrudge anyone–just wish we knew then what we know now.)

I look forward to your response.

Thank you very much.